[Robot-assisted pancreatic resection]. / Roboterassistierte Pankreasresektion.

Although robot-assisted pancreatic surgery has been considered critically in the past, it is nowadays an established standard technique in some centers, for distal pancreatectomy and pancreatic head resection. Compared with the laparoscopic approach, the use of robot-assisted surgery seems to be advantageous for acquiring the skills for pancreatic, bile duct and vascular anastomoses during pancreatic head resection and total pancreatectomy. On the other hand, the use of the robot is associated with increased costs and only highly effective and professional robotic programs in centers for pancreatic surgery will achieve top surgical and oncological quality, acceptable operation times and a reduction in duration of hospital stay. Moreover, new technologies, such as intraoperative fluorescence guidance and augmented reality will define additional indications for robot-assisted pancreatic surgery.

[Hospital cooperation models. Safeguarding optimized patient care, medical training and resource utilization]. / Krankenhaus-kooperationsmodelle. Nachhaltige Sicherung einer optimierten Patientenversorgung, Weiterbildung und Ressourcenauslastung.

INTRODUCTION: In the face of continuous medical progress on the one hand and the increasing cost pressure through the diagnosis-related groups (DRG) system with concomitant hospital privatization on the other, pioneering and economical models for modern and competent patient care are required. METHODS: The cooperation model of the surgical department of the Heidelberg University Hospital is based on patient selection according to the grade of disease complexity and has been successfully developed in Heidelberg since 2005. The long-term results on the basis of actual proceeds are presented. RESULTS: Cooperation with the Salem Hospital chaired by the director of the University surgical department has been ongoing for 6 years. General visceral surgery cases with low complexity are treated at the secondary cooperation hospitals whereas complex oncological operations of the esophagus, liver, pancreas, rectum or multivisceral resections and transplantations are performed at the University hospital. Optimal utilization of the operative and infrastructural resources of both cooperation partners lead to an improvement in surgical training and proceeds. Likewise, another cooperation with the secondary hospital in Sinsheim, which started 2 years ago, has shown similar positive results. Clinical rotation for surgical residents and attending surgeons guarantee a complete and competent surgical training in the field of general surgery. CONCLUSIONS: The long-term results indicate that the cooperation model functions to achieve an optimized treatment of patients and an economical win-win situation for all cooperation partners by differential utilization of the available resources in the hospital network.

[German general and visceral surgery: positioning within the international scientific community]. / Deutsche Allgemein- und Viszeralchirurgie: Positionierung im internationalen wissenschaftlichen Vergleich

BACKGROUND: Assessment of scientific performance is critical for selection committees and research funding. The present work evaluated the standing of German surgical research within the international community. METHODS: A database analysis was performed in December 2009 using the ISI Web of Science. RESULTS: The highest impact factor of surgical journals is currently 8.460 with a median impact of all journals of 1.369. Leading academic surgeons have an h-index of more than 60. German surgeons are within the top five leading researchers in the fields of surgery for esophageal and pancreatic cancer, thyroid, hernia, and liver/kidney transplantation. Among the 50 institutions with most publications on a particular topic, 4-5 German centers are mostly represented. The top positions are in total decisively occupied by leading universities in the USA. CONCLUSION: On the basis of scientific parameters German surgical research can compete with leading international centers in certain fields, but should aim to increase the overall impact of research by publishing more in journals with above average impact factors.